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Developing Concepts in Caring Science Based on a Lifeworld Perspective

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Developing Concepts in Caring Science Based on a Lifeworld Perspective International Journal of Qualitative Methods 4 (2) June 2005 Developing Concepts in Caring Science Based on a Lifeworld Perspective Margareta Asp and Ingegerd Fagerberg Margareta Asp, RNT, BNSci, PhD, Senior Lecture, Department of Caring and Public Health Sciences, Malardalen University, Eskilstuna, Sweden Ingegerd Fagerberg, RNT, MsoSci, PhD, Associate Professor, Department of Caring and Public Health Sciences, Malardalen University, Västeras, Sweden Abstract: Concept development is a significant form of inquiry to expand and develop the knowledge base in caring science. The authors’ aim in this article is to illuminate the possibility of working with concept development, based on a life world perspective, especially Merleau-Ponty’s philosophy of lan- guage, wherein phenomenological, semiological, and pragmatic dimensions are included. The theoreti- cal discussion shows that it is possible to create methodological principles for concept development based on epistemological foundations that are consistent with ontological assumptions in caring sci- ence. Keywords: concept development, phenomenology, lifeworld, caring science Citation Asp, M., & Faberberg, I. (2005). Developing concepts in caring science based on a lifeworld perspective. International Journal of Qualitative Methods, 4(2), Article 5. Retrieved [insert date] from http://www.ualberta.ca/~iiqm/backissues/4_2/pdf/asp.pdf 2 Asp, Fagerberg CONCEPTS IN CARING SCIENCE Introduction The nursing profession is based on approved experiences and scientific knowledge. Historically, medi- cine was the first and only scientific paradigm for nurses’ work. Since the middle of the 20th century, however, different scientific perspectives, such as psychology, sociology, and other social sciences, in- fluenced the knowledge base in the nursing profession. These scientific perspectives could not fully de- scribe and explain the phenomena of caring. Consequently, since the late 1970s, the discipline of caring science has been evolving (Eriksson, 2001). Theories in caring science are developed from the perspec- tive of caring and also from the patients’ perspectives (Dahlberg, Segesten, Nyström, Suserud, & Fagerberg, 2003). Therefore, theories in caring science can be used in the nursing profession and also in other health care professions (cf. Svenson, 1997). To develop an autonomous discipline, however, basic research is needed. The ambition for basic research in caring science is to create theoretical foundations describing and explaining the meaning of caring and the conditions for caring. Methodological consider- ations that have been described regarding concept development for nursing research can be related to the same issue within caring science. According to Morse (1995), the theoretical basis is the foundation for nursing research and practice, and the most urgent need for methodological development exists in the area of conceptual inquiry. Con- cept development is, according to Rodgers (2000a), a significant form of inquiry to expand and develop the knowledge basis of nursing. Individual knowledge and approved experiences in caring remain im- plicit in practice and need to be theorized to become common knowledge. If phenomena regarding as- pects of caring can be conceptualized, the concepts can function as tools, illuminating practice and helping the researcher to study practice from the scientific caring perspective. Concept development is also regarded as necessary for the development of a common professional language as a reliable founda- tion for professional care givers’ and nurses’ work (cf. Eriksson, 1997; Gift, 1997; Meleis, 1997; Morse, 1995). In this article, the term concept development is used to encompass the entire conceptual process (cf. Gift, 1997; Meleis, 1997). The importance of theory and concept development has been elucidated in several nursing confer- ences in Scandinavia during the past 5 years (Hamrin, Lorensen, & Östlinder, 2001; Svensk sjuksköterskeförening [SSF], 2001), which shows that there is an ambition in the Nordic countries to de- velop concepts and theories within caring science and not only use theories from other scientific disci- plines. Concept development is scientific work based on assumptions in philosophical ideas about con- cepts, described as processes of human thoughts, as related to an empirical reality, to language, and to social contexts (cf. Rodgers, 2000a). The philosophical mainstream for concept development is analyti- cal philosophy, as logic positivism, derived from, for example, Locke (1975), Frege (1976), Hempel (1972), and, earlier, Wittgenstein (cited in Flor, 1987), and as “ordinary language” philosophy derived from later Wittgenstein (1978) and Ryle (1963). Another philosophical perspective for this issue is prag- matism derived from Pierce (1932). Several models (cf. Eriksson, 1997; Rodgers, 2000b; Schwartz-Barcott & Kim, 2000; Walker & Avant, 1994) for concept development have been used in nursing and caring science. The models are based on different philosophical perspectives and sometimes also on different perspectives in the same model. To choose models for concept development, the re- searcher has to be aware of the model’s philosophical underpinnings. In other words, the assumptions on ontological, epistemological and methodological levels must be consistent (Kirkevold, 2001). Ontological assumptions The perspective for research in caring science is derived from assumptions about the meaning of the con- sensus concepts; human being, health, suffering, environment, and caring (Eriksson, 2001; cf. Meleis, 1997). The argumentation in the discussion is here based on the following ontological assumptions re- garding the human being: the human being is holistic and multidimensional, and is regarded as forming a bodily, mental, and spiritual whole (cf. Dahlberg et al., 2003; Eriksson, 2001). There is an assumption that mutual interplay prevails between these dimensions within the individual and between people and International Journal of Qualitative Methods 4 (2) June 2005 Asp, Fagerberg CONCEPTS IN CARING SCIENCE 3 the world. People are considered to be both active and creative and are not to be perceived as simply pas- sive victims of external circumstances. In earlier analytical philosophy, the human being is described in a dualistic way by separating mind and body, and a human’s inner and external reality (Rodgers, 2000a; Stolt & Dahlberg, 1998). In this philosophical perspective, a concept is regarded either as a mental image, ideas derived from Descartes, Kant, and Locke, or as corresponding to an external physical reality according to Frege and the earlier Wittgenstein (Rodgers, 2000a). According to Frege (1976), a sign can be related to a meaning and a ref- erence, so Frege distinguished between a sign’s meaning and its reference in the world. The earlier Wittgenstein (cited in Flor, 1987) developed a picture theory, explaining that every sign directly corre- sponded to a physical object. Concepts are regarded as universal and unchangeable over time. The dual- ism in the earlier analytical philosophy is incongruent with the holistic view on human being, however. Consequently, the philosophical perspective cannot function as epistemological underpinnings for con- cept development in caring science. In later versions of analytical philosophy, the dualism between mind and body is not evident, as the human being is described not at an ontological level but as a disposition for actions. The human being is regarded as his or her actions, so the value of the human being can be related to these actions. This philo- sophical perspective is too narrow as an assumption in caring science, however, because caring some- times concerns people who are unable to act. In this perspective, concepts are regarded as tools for actions and are used according to specific rules in a language game, and their meaning can change over time (Ryle, 1963; Wittgenstein, 1978). In a lifeworld perspective, the philosophical idea concerning the lived body (Merleau-Ponty, 1962/1999) is consistent with presented assumptions of the human being in caring science. The idea of the lived body describes a human being undergoing an experience. The body is regarded as an indivisi- ble, ambiguous existence of the subject-object; a “fusion of soul and body” (p. 84), and, consequently, it cannot be regarded as the sum of its own parts. The body acts as a form of a whole and is perceived as a whole. The idea of the lived body solves some problems inherent in the dualistic idea from Descartes (cited in Grøn, 1987a) that there is a gap between mind and body. In a lifeworld perspective, the assump- tions regarding the human being are points of departure for constituting the epistemological base of con- cept development. Our aim in this article is to illuminate the possibility to work with concept development, epistemologically based on a lifeworld perspective, consistent with ontological assumptions in caring science. A lifeworld perspective Here, a lifeworld perspective has a philosophical basis in commonalities found in, Husserl’s (1970a, 1970b), Merleau-Ponty’s (1962/1999, 1964), Heidegger’s (1962), and Gadamer’s (1980, 1998) philoso- phy (cf. Dahlberg, Drew, & Nyström, 2001). The philosophers provide an epistemological perspective with philosophical concepts such as; lifeworld, intentionality, and circularity. The lifeworld is the world in which we live our daily lives in an ordinary, natural attitude. It is a world of meaning that individuals live
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